3List three ways to prevent 100 points - PreventionList three ways to preventpressure ulcers.PressureUlcerPrevention
4100 points Repositioning Incontinence care Toileting schedules Pressure relief devicesAdequate nutritionSkin inspections weeklyUse of moisturizing lotion and/or barrier creamsAvoid friction/shearingUse of therapy/CRA programs.
5200 points - PreventionHow often should an at-risk resident’s skin be inspected for breakdown?PressureUlcerPrevention
6Daily with personal cares. Documented weekly by licensed nurse. Eleanor M. Savko4/15/2017200 pointsDaily with personal cares. Documented weekly by licensed nurse.
7What do you look/feel for when inspecting a resident’s skin? Eleanor M. Savko4/15/2017300 points - PreventionWhat do you look/feel for when inspecting a resident’s skin?PressureUlcerPrevention
8300 points Changes in skin color and/or temperature Eleanor M. Savko4/15/2017300 pointsChanges in skin color and/or temperatureOpen areas or abrasionsMushy/boggy areaArea painful to touch
9How do you check for bottoming out? Eleanor M. Savko4/15/2017400 points - PreventionHow do you check for bottoming out?PressureUlcerPrevention
10400 points Place hand under chair cushion Eleanor M. Savko4/15/2017400 pointsPlace hand under chair cushion(under hips) or mattress overlay(under shoulders or hips),Lift fingers. Should feel at least 1inch of padding between residentand your fingers.
11Define FRICTION and SHEARING. 500 points – PreventionDefine FRICTION and SHEARING.PressureUlcerPrevention
12500 pointsFRICTION – Skin rubbing over a surface, i.e. sheets SHEARING - When the skin sticks to a surface while the body is pulled/moved.
13Eleanor M. Savko4/15/2017Double Jeopardy200 points – A & PWhat is the body’s first line of defense against infections/microorganisms?PressureUlcerPrevention
14200 pointsDouble JeopardyTHE SKIN Intact skin keeps outside micro- organisms from entering the body.
15What is another name for a pressure ulcer? 200 points – A & PWhat is another name for a pressure ulcer?PressureUlcerPrevention
17300 points – A & PName 3 areas on the body where pressure ulcers are most likely to occur.PressureUlcerPrevention
18300 pointsBony prominences: back of head, ears, shoulders, spine, hips, coccyx/sacrum, inner/outer ankles, heels, toes, sides of feet. Areas that rub: casts, prosthesis.
19What are the first signs of a pressure ulcer? 400 points – A & PWhat are the first signs of a pressure ulcer?PressureUlcerPrevention
20400 pointsPersistent area of redness or discoloration that does not disappear when pressure is relieved
21500 points – A & PWhat is the difference between a stage II and a stage III pressure ulcer?PressureUlcerPrevention
22500 pointsStage II – partial thickness skin loss,, superficial, presents as an abrasion, blister, or shallow crater Stage III – full thickness loss involving subcutaneous tissue, may extend down to, but not through, underlying fascia
23100 points – Risk FactorsList 3 things that put a resident at risk for developing a pressure ulcer.PressureUlcerPrevention
24100 points Certain medical diagnosis/meds Restraints Incontinence Weight lossObesityCognitive impairmentEdemaNewly admitted in past 2 weeksRestraintsIncontinenceImmobilityAcute illnessHistory of pressure ulcersPoor nutrition
25Name 3 sources of moisture that can damage the skin. 200 points – Risk FactorsName 3 sources of moisture that can damage the skin.PressureUlcerPrevention
26200 points Incontinence of urine and/or stool Perspiration Wound drainage
27True or False All pressure ulcers are preventable. 300 points – Risk FactorsTrue or False All pressure ulcers are preventable.PressureUlcerPrevention
28300 pointsFalse Most pressure ulcers indicate an inadequacy in basic care. However terminally ill residents can develop pressure ulcers even though care is appropriate.
29400 points – Risk FactorsCognitive impairment and edema are both risk factors for developing pressure ulcers. Explain why.PressureUlcerPrevention
30400 PointsThe cognitively impaired resident may not recognize pain, remember to change position, or be able to verbalize needs.Edema makes the skin more fragile and may indicate circulatory problems.
31500 points – Risk FactorsA resident has a higher risk of developing a pressure ulcer within the first 2 weeks of admission to a NH. Explain why.PressureUlcerPrevention
32500 points Change in health status Acute illness Immobility from hospital stayNH staff not familiar with the resident’s needs, wants, routine
33Name 2 food sources of protein. 100 points - NutritionName 2 food sources of protein.PressureUlcerPrevention
35200 points - NutritionTrue or False It is important to weigh a resident more often than monthly if they are at high risk or have actual skin breakdown.PressureUlcerPrevention
36200 pointsTRUE Weekly or every other week is best. Nutritional intake and skin health are directly related to each other. Weight loss or excess weight gain can indicate presence of either a physical or nutritional problem.
37300 points - NutritionWhich is more important in preventing or treating a pressure ulcer: nutrition or hydration?PressureUlcerPrevention
38300 pointsBoth are equally important in skin health. You must have adequate protein and calorie intake as well as adequate fluids for pressure ulcers to heal.
39400 points - NutritionWhen feeding a resident, which foods or fluids are most important, i.e. which ones do you start with or encourage most?PressureUlcerPreventionWhen feeding a resident which foods or fluids are most important i.e. which ones do you start with or encourage most?
40400 pointsStart with resident preference but encourage protein sources, fortified foods, high calorie supplements.
41500 points - NutritionTrue or False An obese resident and a very thin resident may both be at risk for developing a pressure ulcer.PressureUlcerPrevention
42500 pointsTRUE Obesity or thinness does not equal good nutritional status. Either resident could be in poor nutritional health. You must look at the overall risk factors.
43True or False Donut-type cushions help relieve/prevent pressure. 100 points – Positioning/RepositioningTrue or False Donut-type cushions help relieve/prevent pressure.PressureUlcerPrevention
44100 pointsFALSE Actually they increase pressure and decrease blood flow. Do NOT use donut cushions.
45200 points – Positioning/Repositioning How can you protect the heels from breaking down when a resident is in bed?PressureUlcerPrevention
46200 pointsFloat heels by using a pillow under lower legs to raise heels off bed.Heel protectors and sheepskins help to reduce friction, but do not prevent pressure ulcers.
47300 points – Positioning/Repositioning If a resident has a pressure ulcer, how do you properly position him on his side i.e. where do you place pillows and why?PressureUlcerPrevention
48300 pointsPlace pillows behind the back, between knees and ankles/feet – keeping the body aligned. This adds padding to bony areas and decreases pressure on bony prominences. Avoid placing resident on the actual ulcer or problem area.
49400 points – Positioning/Repositioning What is one way to organize a resident room to encourage independence and slight position changes?PressureUlcerPrevention
50400 pointsPlace the overbed table within safe reach so the resident is encouraged to reach for personal items i.e. phone, comb, papers, water, etc. but not so far away that it increases their risk for falls.
51What are the rules for frequency of repositioning in bed and chair? Eleanor M. Savko4/15/2017500 points – Positioning/RepositioningWhat are the rules for frequency of repositioning in bed and chair?PressureUlcerPrevention
52500 points Position in bed must be changed at least every two hours. Eleanor M. Savko4/15/2017500 pointsPosition in bed must be changed atleast every two hours.If up in chair, reposition every hour.If alert, teach them to shift weight inchair every 15 minutes.All staff can help prompt/cueresidents to shift their position.
53Jeopardy Game Template adapted from the work of Susan Collins and Eleanor Savko, District Resource Teachers for Hardin County Schools:This material was prepared by the Kansas Foundation for Medical Care, Inc. (KFMC), the Medicare Quality Improvement Organization for Kansas, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.10SOW-KS-NH_PrU-11-22PressureUlcerPrevention